Att få nya tänder med hjälp av tandimplantat är idag en väl etablerad teknik med god prognos. För att kunna operera in implantat i käkbenet måste käkbenet ha tillräcklig volym och kvalité. När benet inte har tillräcklig volym kan det byggas upp till exempel genom att transplantera ben från någon annat ställe. “Guided Bone Regeneration” eller “Styrd ben läkning” är en teknik för ben- uppbyggnad där ett membran skapar ett tomt utrymme ovanför det befintliga benet. Mellan membranet och det befintliga benet skapas ett blodkoagel som senare omvandlas till nytt ben. De membraner som idag finns tillgängliga på marknaden är mjuka vilket begränsar användningsmöjligheterna.
Det övergripande målet med denna avhandling var att introducera och utvärdera en ny metod för styrd ben läkning genom att använda ett membran av keramiskt material.
I de 3 inledande djurstudierna användes kanin som försöksdjur. Härvid utvärderades hur en rå yta påverkar ben läkningen. Vidare utvärderades hur en porös keram påverkar ben läkningen, hur en keram med hål i påverkar ben läkningen samt hur olika keramiska material (hydroxyapatit och Zirconia) påverkar ben läkningen. Fem olika sorters kupor (12 st av varje sort) fästes på skallbenet på kaniner och täcktes med benhinnan och huden. Dessa fick läka i 12 veckor innan kaninerna avlivades och därefter analyserades resultatet. Resultatet mättes med röntgen och vävnadsprover. Slutsatsen blev att en keramisk barriär av Zirconia med en rå inneryta utan hål var den bästa lösningen.
Efter djurförsöken gjordes behandlingar på 3 stycken patienter med keramiska membraner. Patient 1 hade för smalt käkben i överkäkens sidoparti, patient 2 hade för smalt och för lågt ben i överkäksfronten och patient 3 hade för lågt ben i underkäkens båda sidor. Membranen var anpassade för varje individ och passade perfekt. Operationen för att fästa membranen tog kort tid och patienterna hade inga komplikationer under läkningen. Efter 7 månader avlägsnades membranen och implantat kunde installeras komplikationsfritt och efter ytterligare en läk period kunde patienterna få nya tänder ovanpå implantaten. Benläkningen utvärderades med datortomografi röntgen, vävnadsprover och tredimensionellt fotografi. Resultatet visade att ”styrd ben läkning med hjälp av keramiska membraner är förutsägbart med gott resultat. Slutsatsen blev att individuellt anpassade keramiska membran ger operatören möjlighet att designa formen på det nybildade benet med ett förutsägbart resultat utan att behöva transplantera ben.
ACKNOWLEDGEMENTS
This project has been an amazing experience for me and would not have been possible without a lot of helping hands along the way. I would like to express my thanks to all of you, and especially: Ann Wennerberg, my main supervisor for sharing your knowledge of the scientific process and for always being available for questions and discussions.
Sten Isaksson, my co-supervisor for inspiration and for a neverending source of new ideas. Thank you also for guiding me through my dental studies, sending me to the Royal London Hospital in 2006 and guiding specialist training.
Peter Abrahamsson, my co-supervisor for inspiration and for making it possible to do research at Specialisttandvården in Halmstad. Thank you also for the time you take discussing scientific work and life in general.
Johan Malmström, my co-author for endless discussions about ceramic materials and how to raise kids.
Ryo Jimbo, my co-author for help with a lot of practical issues and co-authorship. Thank you for showing me a piece of Japan.
Erik Adolfsson, my co-author for technical expertise concerning ceramic materials, for manufacturing the ceramic components and for answering a lot of necessary and unnecessary questions.
Silvia Galli, for helping me urgently with the animal samples before the trip to Japan.
Lars-Åke Johansson, for interesting discussions about this research project and ideas along the way. Thank you for lending me that book. Dan-Åke Wälivaara, my co-writer and for helping me with the photos. Tomas Albreksson, for inspirational discussions and review of texts. Anders Holmén, for help with computers, computer programs and statistical calculations.
Rishi Bandari, my English colleague and friend for helping out with the English grammar of the final thesis.
Chris Reynolds, my American cousin for helping out with the language review of the final thesis. Thank you also for reading this work critacally and reviewing the facts. Best regards to all your family. Yusuke Kozai, my co-author for helping out with the micro-CT investigations.
Yoshihito Naito, my co-author for helping me with sawing and grinding.
Fredrik Hallmer, my co-author for a helping hand during animal surgery and for the good company during dental training and all courses.
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